Center for Gynecologic Oncology Amsterdam, Netherlands Cancer Institute/Antoni van Leeuwenhoek and Amsterdam University Medical Centers, the Netherlands; Department of Oncology, KU Leuven, Leuven, Belgium.
Department of Obstetrics and Gynecology, Centre Hospitalier de Poissy-Saint-Germain-en-Laye, Poissy, France.
Ann Oncol. 2019 Oct 1;30(10):1601-1612. doi: 10.1093/annonc/mdz228.
We aimed to provide comprehensive protocols and promote effective management of pregnant women with gynecological cancers. New insights and more experience have been gained since the previous guidelines were published in 2014. Members of the International Network on Cancer, Infertility and Pregnancy (INCIP), in collaboration with other international experts, reviewed existing literature on their respective areas of expertise. Summaries were subsequently merged into a manuscript that served as a basis for discussion during the consensus meeting. Treatment of gynecological cancers during pregnancy is attainable if management is achieved by collaboration of a multidisciplinary team of health care providers. This allows further optimization of maternal treatment, while considering fetal development and providing psychological support and long-term follow-up of the infants. Nonionizing imaging procedures are preferred diagnostic procedures, but limited ionizing imaging methods can be allowed if indispensable for treatment plans. In contrast to other cancers, standard surgery for gynecological cancers often needs to be adapted according to cancer type and gestational age. Most standard regimens of chemotherapy can be administered after 14 weeks gestational age but are not recommended beyond 35 weeks. C-section is recommended for most cervical and vulvar cancers, whereas vaginal delivery is allowed in most ovarian cancers. Breast-feeding should be avoided with ongoing chemotherapeutic, endocrine or targeted treatment. More studies that focus on the long-term toxic effects of gynecologic cancer treatments are needed to provide a full understanding of their fetal impact. In particular, data on targeted therapies that are becoming standard of care in certain gynecological malignancies is still limited. Furthermore, more studies aimed at the definition of the exact prognosis of patients after antenatal cancer treatment are warranted. Participation in existing registries (www.cancerinpregnancy.org) and the creation of national tumor boards with multidisciplinary teams of care providers (supplementary Box S1, available at Annals of Oncology online) is encouraged.
我们旨在提供全面的方案，并促进妇科癌症孕妇的有效管理。自 2014 年发布前指南以来，已经获得了新的见解和更多的经验。国际癌症、不孕和妊娠网络（INCIP）的成员与其他国际专家合作，审查了各自专业领域的现有文献。随后将摘要合并成一份手稿，作为共识会议讨论的基础。如果通过多学科医疗保健提供者团队的合作来管理妇科癌症，就可以实现对其的治疗。这允许进一步优化产妇治疗，同时考虑胎儿发育，并为婴儿提供心理支持和长期随访。非电离成像程序是首选的诊断程序，但如果对治疗计划必不可少，则可以允许有限的电离成像方法。与其他癌症不同，妇科癌症的标准手术通常需要根据癌症类型和妊娠年龄进行调整。大多数标准的化疗方案可以在妊娠 14 周后给药，但不建议在 35 周后给药。大多数宫颈和外阴癌建议行剖宫产，而大多数卵巢癌允许阴道分娩。正在进行化疗、内分泌或靶向治疗时应避免母乳喂养。需要更多关注妇科癌症治疗的长期毒性作用的研究，以充分了解其对胎儿的影响。特别是，在某些妇科恶性肿瘤中成为标准治疗方法的靶向治疗的数据仍然有限。此外，需要更多的研究来定义产前癌症治疗后患者的确切预后。鼓励参与现有的登记处（www.cancerinpregnancy.org）和创建具有多学科护理团队的国家肿瘤委员会（补充框 S1，可在《肿瘤学年鉴》在线版获取）。
